Coprostasis
Description:
The coprostasis syndrome (obstipation) is the frequent satellite of diseases of digestive tract. Over 48 h, but also, the regular incomplete or complicated bowel emptying with allocation less than 100 g a calla are considered to be obstipation a chair delay.
Coprostasis symptoms:
Accumulation of fecal masses (is more often in terminal sites of a small or large intestine) is followed by a kolikopodobny or sharp colicy pain in a stomach. Quite often overall health suffers: there is a weakness, nausea, vomiting, pallor, temperature increases. At a palpation dense education or fecal conglomerates are determined by the intestines course.
Coprostasis reasons:
There is a set of classifications of etiological factors of a coprostasis. Following is most often used.
I. Alimentary coprostasis.
II. Mechanical coprostasis (organic lesions of a large intestine).
III. Neurogenic coprostasis (functional and organic diseases of the central nervous system).
IV. Toxic coprostasis (chronic intoxications, including medicines).
V. A coprostasis at endocrine pathology.
VI. A reflex coprostasis (at various diseases of bodies of digestive tract and small pelvis).
Coprostasis at organic lesions of a large intestine. Obstipation is one of the most characteristic symptoms of congenital anomalies of development of a large intestine — idiopathic megacolon, a disease of Girshsprunga, mobile blind and sigmoid guts.
In addition, the coprostasis develops also at secondary megacolon, and also in the presence of various mechanical obstacles in a way of a passage of intestinal contents (a tumor, a stricture, an intestines prelum commissural process, conglomerates of lymph nodes and so forth).
Expansion of all or parts of a colon (megacolon) often is followed by its lengthening (megadolichocolon). At the same time the expressed thickening of an intestinal wall is noted. Most often, however, these inborn changes meet in a sigmoid gut — a dolichosigma. The dolichosigma makes 15% of all inborn pathology of bodies of digestive tract.
The dolichosigma can proceed without the expressed symptomatology at children's age, however in the presence of the accompanying pathology of bodies of digestive tract is followed by persistent obstipation. The coprostasis develops at such patients more often at youthful or even mature age.
At dolichosigma excesses, and also at mobile sigmoid and blind guts there can be pains in the right or left half of a stomach with irradiation in an epigastrium or paraumbilical area.
In diagnosis the dominating role is played by X-ray inspection of a large intestine, and also a kolonoskopiya and a rektoromanoskopiya.
Clinical shows of idiopathic megacolon develop at different age stages that depends on disease type. Megacolon of children's type arises on the first year of life. In addition to a characteristic coprostasis, an incontience the calla quite often develops. Direct and sigmoid guts extend.
The coprostasis which developed at advanced age is characteristic of adult type of idiopathic megacolon. In addition to it, expansion of all colon is noted.
Systematic obstipation for many years is the only symptom of a disease. Spontaneous defecation arises once in 2 — 3 weeks. The chair at the same time of a dense consistence, its diameter and volume is 1,5 — 2 times more than usual. After a while after emergence of a coprostasis nagging pains in a stomach without a certain localization join. They considerably weaken or disappear absolutely after the act of defecation.
The tone of a proctal sphincter in initial stages can be normal or raised. Further the sphincter atony with accession of an incontience a calla can develop. In some cases the full gaping of a sphincter is noted. Skin of perianal area is angry. The ampullar department of a rectum is usually hardly filled with dense excrements.
The dense consistence of fecal masses, and also their considerable volume demand the expressed natuzhivaniye without which the act of defecation becomes impossible. Result long (up to 20 seconds) the natuzhivaniya becomes emergence of anal fissures, hemorrhoids. Painful defecation leads to incomplete bowel emptying.
Quite often there are false, or "locking", ponosa. Their emergence is connected with allocation by the angry mucous rectum of a large number of the secret liquefying fecal masses.
The condensed fecal masses under the influence of segmented reductions of a gut is pressed in coprolites which lead to stretching and a gaping of a proctal sphincter. The fecal masses liquefied by pryamokishechny slime flows round coprolites, passes the gaping sphincter, irritates skin of a perianal zone. A calla patients quite often take an incontience for diarrhea therefore it is necessary to find out the anamnesis of a disease carefully. The expressed weakening of a reflex of the act of defecation is noted, however completely it is not lost.
The disease of Girshsprunga is most often diagnosed at early children's age. It is the inborn malformation of a large intestine connected with total absence (agangliozy), insufficient or abnormal development intramural nervous ганглиев and nerve fibrils of an intestinal wall.
Disturbance of nervous control or full denervation of the site of a large intestine with development of an aperistaltichesky zone and secondary changes of all layers of an intestinal wall is result (mucous, submucosal and muscular).
Because of emergence of an aperistaltichesky zone the passage of intestinal contents is broken. Fecal masses collects in the denervated site of a gut, causing considerable stretching of its walls. The bringing site, on the contrary, strenuously is reduced that causes in the beginning a hypertrophy, and then leads to hypotonia of its muscular layer.
The main clinical display of a disease is lack of an independent chair. After enemas the kcal in the form of "stopper" is allocated. With age the disease of Girshsprunga always progresses. Patients suffer from fecal intoxication. The only method of treatment is the resection of the aganglionarny site and a part of a dilatirovanny zone of a large intestine.
Speak about a disease of Girshsprunga of adults at development of the main symptoms at young and middle age. It is possible in the presence of the small, distally located aganglionarny site of a gut, and also at deficit of nerve knots and fibers in an intestinal wall.
The coprostasis can develop in the presence of a mechanical obstacle to a passage of intestinal contents. In the latter case tumoral process of a large intestine is the most frequent reason.
In addition, can lead a prelum to reduction of a gleam of a gut it from the outside a conglomerate vospalitelno of the changed lymph nodes, commissures or inflammatory (tumoral) infiltrate.
At such incomplete intestinal impassability the size of an obstacle does not play a special role: even if it it is insignificant it is small, the reflex spasm of a gut can lead to full obturation of its gleam. Reception of laxatives, sharp reduction of muscles of a prelum abdominale at a natuzhivaniye can cause a spasm of an intestinal wall.
At tumors of a large intestine development of a "locking" diarrhea is characteristic of a mechanical coprostasis. For diagnosis the test for the occult blood and endoscopic methods of a research of a large intestine have the greatest value.
Coprostasis at intestines diskineziya. Dyskinesia of intestines is carried to the functional diseases connected first of all with changes of nervous control of motor function of a large intestine. As motor disturbances of dyskinesia are divided into hyper - and hypomotor, on the nature of emergence — on primary and secondary.
Primary dyskinesia develop under the influence of psychogenic factors. Quite often they are accompanied by the general neurotization of the personality, however in some cases "intestines neurosis" arises separately, being the only symptom of instability in a stressful situation.
As the majority of neurosises, primary intestinal dyskinesia can develop after once expressed stress or as a result of long influence of the psychoinjuring factor or a situation.
Intestinal dyskinesia meets in an age group from 20 to 50 years, it more often (by 2 — 2,5 times) women suffer.
At a hyper motor form (a syndrome of the "angry" gut) the chair at patients very firm, fragmented, has an appearance of dry small balls — so-called sheep.
As a rule, at objective inspection of any pathological changes in structure of a chair it is not possible to reveal. Obstipation can be replaced with some time by diarrhea with a frequency of chair up to 3 times a day. Quite often patients show complaints to the pains in the left ileal or paraumbilical area amplifying after food. Spazmirovanny, painful sites of a gut are defined by Palpatorno.
Sometimes quite rare form of intestinal dyskinesia — mucous colic develops. It is characterized by the expressed spastic abdominal pains in combination with mucifying in the form of films through an anus.
At hypomotor dyskinesia independent defecation is considerably complicated, but the chair can be large volume, also without pathological impurity. Decrease in a tone of all large intestine is usually noted.
Intestinal dyskinesia at the persons inclined to neurotic reactions, proceeds wavy, and aggravations usually match on time influence of the psychoinjuring factor.
Clinical manifestations of a coprostasis at dyskinesia of a large intestine are quite characteristic and a little in what differ from a coprostasis of other etiology. The long absence of spontaneous defecation leads to emergence of feeling of the raspiraniye and completeness in a stomach passing into dull ache, patients note "empty" desires on a chair, sometimes with an otkhozhdeniye scanty dense a calla without full simplification.
Patients can show the complaints of the most various character connected with the reflex influences proceeding from intestines including on weakness, increased fatigue, sleeplessness, decrease in working capacity, unpleasant smack in a mouth, abdominal distention.
Various vegetative dysfunctions, emotional lability can be noted. In diagnosis an important role is played by radiological and endoscopic methods of a research.
At hyper motor dyskinesia the irrigoskopiya or a method of a double contrast study a baric suspension reveal the spazmirovanny site of a gut having a cord appearance, the deep segmented haustration defined in the form of multiple banners. The passage of a contrast agent is accelerated, not arranged.
Incomplete emptying of a sigmoid gut is noted.
At hypokinetic dyskinesia, in addition to decrease in a tone of a gut or its separate segments, the smoothness of haustration and expansion of a cavity of intestines is defined.
Rektoromano-or the kolonoskopiya at hyper motor dyskinesia reveals existence of a vermicular movement, a wet mucous membrane, certain spazmirovanny sites of a gut. At hypomotor dyskinesia the peristaltics is not visible, the mucous membrane dry and dim, distal department of a gut can be fallen down.
Despite the functional nature of a disease, long obstipation in itself can lead to development of various organic lesions both a large intestine, and other bodies of digestive tract.
At accession of secondary colitis in a chair slime impurity is noted, more often it is on a surface of dry balls a calla in the form of whitish threads.
The coprostasis can be complicated by developing of various anorectal diseases — anal fissures, hemorrhoids, a paraproctitis. Symptoms of pryamokishechny bleeding, pain at the act of defecation then join typical symptoms of obstipation, inflammatory changes of perianal fabrics.
The reflux of contents of a large intestine in thin at a natuzhivaniye can lead to planting of a small intestine microflora of thick unusual for it. Development of acute or chronic enteritis, cholecystitis, a cholangitis can become effect of an intestinal disbioz.
The increased intracavitary pressure in a large intestine is one of intestines divertuculosis origins. Fecal stones which can be formed even at young age quite often lead to development of intestinal impassability.
The chronic coprostasis plays a part in a carcinogenesis: a number of the carcinogens which are products of bacterial metabolism has a possibility of long contact with a mucous membrane of a gut as a result of stagnation of its contents at obstipation.
Secondary intestinal dyskinesia results from reflex influences from patholologically the changed bodies of digestive tract and bodies of a small pelvis. On the secondary nature of disturbances accurate communication between an aggravation of a basic disease and strengthening of a coprostasis, and also disappearance of obstipation specifies in a phase of its remission.
The coprostasis is characteristic of a number of diseases of a stomach — gastritis with normal and hypersecretion, a peptic ulcer. Quite often it accompanies chronic cholecystitis, both calculous, and acalculous. Obstipation develops at every fifth patient with chronic enteritis and at every second — with chronic colitis.
Reflex impacts on a large intestine from bodies of a small pelvis at an urolithiasis, appendicitis, a chronic salpingo-oophoritis and an endometritis also lead to development of intestinal dyskinesia and a coprostasis.
Especially are considered proktogenny dyskinesia at patients with pathology of anorectal area (a proctitis, a paraproctitis, a sphincteritis, hemorrhoids, anal fissures). The coprostasis at this sort of diskineziya arises as thanks to inflammatory changes of a rectum and an anus, and in connection with a reflex spasm of internal and outside sphincters.
At such patients complaints to pathological difficulty of the act of defecation, pain in the field of an anus, allocation with a chair of scarlet blood owing to grazes or cracks, loss of hemorrhoidal nodes and a mucous membrane of a rectum are dominating.
Obstipation is strengthened by conscious strong-willed effort of patients on prevention of defecation which they try to avoid because of the expressed pain.
Treatment of the Coprostasis:
The major factor is purpose of an adequate dietotherapy. The diet has to be physiologically full, with the normal content of all main nutrients, vitamins, microelements and mineral substances. At the same time the additional introduction to a diet of mechanical and chemical stimulators of motor function of intestines excluding those products which cause strengthening in intestines of processes of fermentation and rotting is necessary.
Meal in the boiled and steamed look is shown, it is not necessary to crush it. As stimulators of motility those kinds of berries, fruit and vegetables which strengthen evakuatorny function of intestines are used, without causing at the same time processes of fermentation and irritation mucous intestines.
The diet at various types of diskineziya has to correspond to features of motility of intestines. At hypomotor dyskinesia of a large intestine the basic principle of a dietotherapy is addition in a diet of the following products rich with a cellulose: carrots, beet, vegetable marrows, pumpkin, a cauliflower, tomatoes, sheet salad in a crude and boiled look. The vegetables rich with essential oils are excluded: turnip, radish, onions, garlic, garden radish, and also mushrooms. Bread from rye and wheat flour of a rough grinding with addition of bran, porridges from wheat, buckwheat, pearl-barley, oat grain on water is recommended.
Soups are cooked on rather weak fat-free beef-infusion and fish broth, vegetable broth. Meat and fish — only low-fat grades — boiled, steam, baked, preferential a piece. At good tolerance of proteinaceous food it is possible to take soft-boiled eggs or in the form of steam omelets — no more than 2 pieces a day.
Fruit and vegetable juice, and also fig, dates, prunes, dried apricots, bananas, apples as organic acids and sugar which contain these fruit stimulate motility of intestines are shown. Lactic products are effective in therapy of a coprostasis: fresh kefir, curdled milk, acidophilus milk, and also drinks with addition of live culture of bifidobacteria.
Bowel emptying is promoted by food cold. Addition in a diet of wheat bran which drenches with boiled water and is used in pure form or added to liquid dishes (in the first two weeks on 1 h l. 3 times a day, further on 1 — 2 tablespoon 3 times a day with the subsequent dose decline to 1,5 h l. 3 times a day), bowel emptying allows to facilitate considerably. It is necessary to accept them for not less than 6 weeks. At hypomotor diskineziya it is possible to appoint vegetable and animal oils (sunflower, corn, olive, creamy, etc.).
Bread from high-grade flour, fancy pastry, fat grades of meat, a smoked product, canned food, hot dishes, chocolate, strong coffee, tea are not shown. The rice and semolina porridges, vermicelli, potatoes, products causing the increased gas generation are not recommended (bean, cabbage, a sorrel, spinach, apple and grape juice).
At hyper motor dyskinesia of a large intestine, and also at a proktogenny coprostasis fundamental difference is purpose of a besshlakovy diet with the considerable content of vegetable fats as the food rich with cellulose can cause strengthening of a spastika and abdominal pain.
In process of improvement of a condition of motor function of a gut vegetables, at first in a boiled look, and then and crude, and also juice are gradually entered. With care and in the minimum doses it is necessary to use wheat bran which can cause a meteorism and kolikopodobny abdominal pains in such patients. It is necessary to begin with reception 1 h l. in the mornings.
Drug treatment of diskineziya of a large intestine is applied in the last turn. At hyper motor dyskinesia appoint:
— spasmolysants of various groups (including cholinolytics, and also adrenomimetik, ganglioblokator);
— Metoclopramidum (cerucal);
— local therapy in the form of oil microclysters, spasmolytic candles.
At hypomotor dyskinesia are shown:
— the drugs of different groups increasing motility of intestines (мотилиум, цизаприд, дебрадат, координакс);
— Metoclopramidum (cerucal);
— cholagogue drugs (Allocholum, festal) and fermental means;
— potassium chloride in combination with B1 vitamin;
— antikholinesterazny means (прозерин, Galantaminum).
Use of purgatives should be avoided, at hyper motor dyskinesia they are completely contraindicated.
At hypomotor dyskinesia with lack of effect of therapy above-mentioned means apply laxatives. Preference should be given to drugs of a plant origin: to a leaf of Senna, buckthorn bark, buckthorn, rhubarb and products of their processing. It is necessary to appoint purgatives not to a thicket 2 weekly, it is better to alternate them among themselves.
